Table 1 Study objectives

Primary objectives

1. Does the adherence to the country/state package of ANC interventions by health workers improve with the country/state-specific ANC package?

  a. Does the implementation of country/state-specific ANC package (including targeted community mobilization) increase early initiation of ANC among pregnant women?

2. Is the country/state-specific ANC package acceptable to and does it create value for women and health workers?

Secondary objectives

1. What are the human resources training and supervision needs of implementing the country/state-specific ANC package?

2. What is the cost of implementing the country/state-specific ANC packages compared with standard of care?

3. What are the effects of the ANC package on retaining women in ANC services? (Burkina Faso only)

Formative phase

1. Adapt the WHO digital ANC module to the country-specific ANC package and local healthcare delivery context, customizing the ANC Digital Adaptation Kit (DAK) [36]

2. Identify bugs and errors in the clinical algorithms and in the country-adapted ANC digital module

3. Gather general feedback regarding the usability of the country-adapted ANC digital module and components for improvement

4. Develop and test training materials for the country-adapted ANC digital module

5. Develop and test supervision and technical support mechanisms for the country-adapted digital ANC module

Demonstration phase—primary objectives

1. Does the adherence to the country/state package of ANC interventions improve among health workers using the adapted WHO digital ANC module compared with standard care?

  a. Does the implementation of the country-specific ANC package (including targeted community mobilization) increase early initiation of ANC among pregnant women?

2. Is the use of the country-adapted WHO digital ANC module acceptable to, and does it create value for, women and health workers?

Demonstration phase—secondary objectives

1. What are the human resources training and supervision needs to ensure fidelity of deployment of the adapted WHO digital ANC module?

2. What are the financial resources needed to implement the adapted WHO digital ANC module for the study, and what resources would be needed to achieve scale?